What Is the Treatment of Hereditary Hemochromatosis?
Clinical Overview
Hereditary hemochromatosis is associated with iron overload. When iron overload is confirmed, active iron depletion is indicated. Treatment is structured across two phases: an induction phase to deplete accumulated iron stores, followed by a maintenance phase to sustain target levels long-term.
Treatment Approach
The first-line intervention for iron depletion is therapeutic phlebotomy. Where available, erythrocytapheresis is an established alternative. The protocol also incorporates specific guidance on supplementation and dietary factors. Phlebotomy is adjusted based on the patient's haemoglobin response — including when to reduce frequency and when to pause — and the complete schedule is defined in the full protocol.
Treatment Goals
Induction phase
Serum ferritin 50 µg/L (not lower, to avoid iron deficiency)
Maintenance phase
Serum ferritin 50–100 µg/L
References
DOI: 10.1016/j.jhep.2022.03.033
- Patients with haemochromatosis and evidence of iron overload should undergo iron depletion therapy.
- The first-line treatment for iron depletion is therapeutic phlebotomy.
- Erythrocytapheresis is an alternative to therapeutic phlebotomy and has been shown to be cost effective in the induction phase, because fewer interventions are required, and it can be an option if available.
- The target for iron depletion during induction is a serum ferritin of 50 µg/L, but not lower to avoid iron deficiency.
- In the maintenance phase, serum ferritin can be maintained with some flexibility in the range of 50–100 µg/L.
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